Purpose. Gateway providers are individuals who first identify a problem and send a youth to treatment. They are frequently social service workers. However, for American Indian youth they can also be informal providers or traditional healers. Studies examining the determinants of their actions might improve community service capacity. Methods. Four hundred one American Indian youth (half urban and half reservation based, aged 12 to 19) were first interviewed in 2001. The study then interviewed 190 gateway providers, who offered services to 212 of the youth. Youth and provider data were merged. Results. Structural Equation Modeling revealed that referral to, recommendation of, or direct provision of services was influenced largely by gateway provider knowledge of the youth and of service resources, with provider type (informal, traditional, nonspecialist [like a social service worker, counselor, teacher], or specialist) contributing minor variance. In all, 31% of the variance in provider actions was determined by provider assessment of youths' mental health (.36), provider resource knowledge (.28), and provider type (.16). In turn, 39% of the variance in provider perception of youth problems was influenced by youth self-reported mental health (.34), and provider perception of the youth's environment (.49). Thirty-three percent of the variance in provider resource knowledge was influenced by inservice training (.40), provider type (.21), and youth self reported mental health (.16). As in other tests of the model, youth report of their own mental health did not contribute directly to variance in services (Stiffman, Hadley-Ives, Dore, et al, 2000). The values of all SEM indices were high, with the Adjusted Goodness of Fit Index (AGFI) equaling .91 Implications for practice. results support earlier SEM models on other data sets that demonstrate the pivotal role of gateway providers in services (Stiffman, Pescosolido, & Cabasso, 2004). Providers may be more likely to both identify youth's problems and refer youth to services when two pieces of information are in place: 1) knowledge of community resources available to youth; and 2) knowledge of assessment.

Funded by NIMH1 R34 MH072871-01, 1 R24DA13572-01, and 1 K02 MH01797-01A1